Solution to Musculoskeletal Injuries in Sonography
Sonography, as a profession, is often enticing. When most individuals think of sonography, the thought that comes to mind is a sonogram with the pictures of a baby in gestation within a mother’s womb. Though this can be an interesting and rewarding career choice, this profession, as in most, can have its drawbacks. Many sonographers are at risk of suffering from musculoskeletal injuries and a significant amount are already experiencing injuries, especially those with considerable workloads and ones who have been in the profession for a large amount of time. In order to make sonography a safer profession, the work environment of sonographers must be redesigned with better ergonomics in mind. Having a safer ergonomic design must play an essential part of equipment design, along with changes to the layout of the work setting.
Musculoskeletal Disorder also known as work-related musculoskeletal disorder (WRMSD) can include a number of symptoms ranging from swelling and inflammation of the muscles, spasms, tingling or burning sensations, to the loss of sensation completely (Coffin, 2014). In certain cases, a loss of muscle strength can occur. While this disorder is accumulative, the symptoms considered to be small can evolve to become more critical and also debilitating. Among North American sonographers in 1997, the occurrences of musculoskeletal injury were 84% and increased to 90% in 2008 (Coffin, 2014).
According to the Bureau of Labor Statistics (BLS), work-related musculoskeletal disorders are currently responsible for up to one-third of all illnesses reported by employers every year (Preventing Work, 2006). There are numerous influences which precede to musculoskeletal disorder throughout a cycle of time: awkward positions and movement stemming from the persistent and recurrent use of the transducer and positioning of both patients and equipment, perpetual and repeated pressure for unrelenting amounts of time throughout exams, inadequate workplace ergonomics in the design of equipment, chairs, tables, and lighting, increased exam scheduling, and the age, gender, and height of sonographers (Preventing Work, 2006).
Previous Studies and Evidence
Musculoskeletal disorders in health care workers have been correlated in great portion to patient transfer and lifting activities. Biomechanical studies have shown that these activities place high levels of compressive force on low back structures, exceeding the lifting limits recommended by the U.S. National Institute for Occupational Safety and Health (NIOSH). Shoulder, knee and other disorders have also been associated with patient lifting and transferring tasks (Tullar, Amick, & Mahood).
While over a span of a year, randomized controlled trials were performed. The trials were two different physical-activity programs to decrease musculoskeletal symptoms in the neck and shoulders (Blangsted, Søgaard, & Hansen, 2001). Data was presented about two different worksite physical-activity interventions that could perhaps lead to a method of prevention for musculoskeletal disorder. Two interventions were conducted. The first intervention was specific resistance training (SRT), which is a form of physical activity used to improve muscular fitness (Esco, 2013). The second intervention was all-round physical exercise (APE) which is all types of physical fitness (Blangsted et al., 2001). The duration and intensity of neck and shoulder symptoms was less following the specified worksite physical-activity interventions than in the reference group. On an intervention group level, specific resistance training (SRT) was no more effective than all-round physical exercise (APE) in reducing the duration and intensity of neck and shoulder symptoms. A critical review concluded that worksite physical activity programs may have a positive effect on reducing musculoskeletal disorders (Blangsted et al., 2001).
Changes to Ergonomic Design
Along with the worksite physical activity programs, implementing changes to the ergonomic design of the work environment will also greatly affect the safety of sonographers. State-of-the-art equipment makes it possible for best visualization which increases diagnostic accuracy and reduces sonographer fatigue. The economic aspect of ergonomics is also a crucial concern that should be looked at closely. A workstation including the expense of an ergonomically designed state-of-the-art ultrasound system, a table, chair, and accessories can be purchased for $188,200 (Sound Ergonomics, 2003). In contrast, failure to address ergonomics in the workplace setting can result in $580,000 in revenue loss, medical bills, average cost of a Worker’s Compensation claim, and new staff recruitment. Temporary staffing from an agency could possibly cost an additional $80,000 (Sound Ergonomics, 2003).
Change in Design of Ultrasound Equipment
Entirely adjustable equipment that suits the anthropometrics, a measurement or description of the physical dimensions and properties of the body, will positively affect the 5th to 95th percentile of sonographers (Sound Ergonomics, 2003). It seems necessary that ultrasound machines have easily accessible controls to attain two-wheel, four-wheel, and braked positions. Central locking is also a desirable feature. Having recording mechanisms on the machines placed where it minimizes the sonographer’s reach to external devices is a must; external devices should not restrict the adjustability of the system (Sound Ergonomics, 2003). Including a footrest on the sonogram equipment would promote neutral position of the ankles. The transducer holder helps with accessibility; the distance from the holder to the machine controls must be within arm’s length or less and should not require much force making it easy for single-handed use (Sound Ergonomics, 2003). The new design of all ultrasound systems would need to ensure that the equipment does not exceed over 50 pounds of force for pushing or pulling by a single sonographer on normal flooring surfaces. If over 50 pounds, it needs to be a requirement that additional persons are on hand to help with the moving of equipment. Height-adjustable handles added onto the newly designed equipment would also help with transportation (Sound Ergonomics, 2003). In addition, the ultrasound scanning system would be better equipped with small, light-weight transducers that have thin and flexible cables. The cables must be accessible and not restrict with retrieval of equipment or system interaction.
Design Changes to Ultrasound Machine Control Panel
Design changes to the control panel of sonogram machines are needed. Height-adjustable control panels, independent from the monitor with proper level of angle to permit for the sitting or standing sonographer to accomplish neutral position of wrist and forearm. Individual movement of control panel lets the sonographer work and uphold their elbow at their side (Sound Ergonomics, 2003). The control arrangement can be enhanced to allow the sonographer to use both right and left hands. The shapes, sizes, and spacing of controls must be designed to occupational ergonomic guidelines as well as, the size of font and control arrangement (Sound Ergonomics, 2003).
Design Changes to Ultrasound Machine Monitors
Changes that need to be made to the design of ultrasound machine monitors include features to reduce eye strain such as, minimized flicker, suitable brightness and contrast levels, resolution, and visual contrast (Sound Ergonomics, 2003). Monitors need to be height-adjustable, and independent from the control panel with proper amount of angle to allow the standing or seated sonographer to attain neutral posture of their neck. The monitor needs to permit sonographers to work while upholding their neck in a frontward and neutral position (Sound Ergonomics, 2003).
Design Changes to Patient Exam Tables
The change in design of patient exam tables are one of the top things in the exam rooms that needs the most consideration for change. The exam tables need height-adjustability, capable of being adjusted low enough so that patients can get on and off without being assisted, and to permit the sonographer to do the scan while in a seated or standing position while sustaining arm abduction (Sound Ergonomics, 2003). The exam tables would be more efficient if maneuverable, with complete wheel mobility, and wheel locks that are effortlessly controlled. Open space from every angle of the exam table allows the sonographer to place their knees and feet beneath when needed. Any support structure or mechanism of exam table needs to not extend above the table top, as this hinders the sonographer from minimizing reach and arm abduction (Sound Ergonomics, 2003).
Better Seating for Sonographers Lastly, the need for a chair instead of a stool will greatly affect the sonographer’s posture and ergonomic safety. Along with other equipment in the exam room, the sonographer’s chair must be height-adjustable with enough adequate range to suit every sonographer. The chair needs alterable lumbar support, alterable seat for thigh support, and alterable footrest. Design of the chair must promote an upright seated posture (Sound Ergonomics, 2003).
Conclusion
In order to lessen injuries related to musculoskeletal disorder in the profession of sonography, it is a must that what has been proposed, as far as the redesigning of ultrasound equipment to improve ergonomics, these changes need to be implemented in order to safeguard sonographers from needing to contort their bodies and encompass themselves in poor postural alignment. In an ideal environment, the sonographer’s body must be as close as possible to both the patient and the equipment, decreasing the need for the sonographer to extend their reach or acquire poor posture. The change in equipment design will help tremendously in small ultrasound scanning rooms by allowing for best equipment positioning.

References
Blangsted, A. K., Søgaard, K., Hansen, E. A., Hannerz, H., & Sjøgaard, G., (2008). One-year randomized controlled trial with different physical-activity programs to reduce musculoskeletal symptoms in the neck and shoulders among office workers. Scandinavian Journal of Work, Environment & Health, 34(1), 55-65. Retrieved from http://search.proquest.com/docview/201490292?accountid=13993
Coffin, C. T. (2014). Work-Related musculoskeletal disorders in sonographers: A review of causes and types of injury and best practices for reducing injury risk. Reports in Medical Imaging, 715-26.
Preventing Work - Related Musculoskeletal Disorders in Sonography. (2006). Retrieved from https://www.sdms.org/pdf/NIOSH_MSI_sonography_28september2006.pdf
Esco, M. (2013). Resistance Training for Health and Fitness. Retrieved from http://www.acsm.org/docs/brochures/resistance-training.pdf
Sound Ergonomics. Manpower Shortages are Costly. (2003). Retrieved from http://www.soundergonomics.com/Pages/Admin_Risk/ergoeconomics.htm Accessibility
Tullar, J. M., Brewer, S., Amick, B. C., Irvin, E., Mahood, Q., Pompeii, L. A., Evanoff, B. (2010). Occupational safety and health interventions to reduce musculoskeletal symptoms in the health care sector. Journal of Occupational Rehabilitation, 20(2), 199-219.